The Hamilton Rating Scale for Depression (HAM-D)

Name or ID: Date:

For each item select the one “cue” which best characterizes the patient.

1. Depressed Mood (Sadness, hopeless, helpless, worthless) 6. Insomnia, Delayed

0 Absent 0 No difficulty
1 These feeling states indicated only on questioning 1 Waking in early hours of the morning but goes back to sleep
2 These feeling states spontaneously reported verbally 2 Waking in early hours of the morning and unable to go back
3 Communicates feeling states nonverbally—ie, through facial to sleep
expression, posture, voice, and tendency to weep
4 Patient reports VIRTUALLY ONLY these states in his/her 7. Work and Interests
spontaneous verbal and non-verbal communication 0 No difficulty
1 Thoughts and feelings of incapacity, fatigue or weakness related
2. Guilt to activities, work, or hobbies
0 Absent 2 Loss of interest in activity, hobbies, or work—either directly
1 Self reproach, feels he/she has let people down reported by patient, or indirect in listlessness, indecision, and
2 Ideas of guilt or rumination over past errors or sinful deeds vacillation (feels he/she has to push self to work or engage in activities)
3 Present illness is a punishment; delusions of guilt 3 Decrease in actual time spent in activities or decrease in
4 Hears accusatory or denunciatory voices and/or experiences productivity. In hospital, rate 3 if patient does not spend at least
threatening visual hallucinations three hours a day in activities (hospital job or hobbies) exclusive
of ward chores
3. Suicide 4 Stopped working because of present illness. In hospital, rate 4 if
0 Absent patient engages in no activities except ward chores or if patient
1 Feels life is not worth living fails to perform ward chores unassisted
2 Wishes he/she were dead or any thoughts of possible death to self
3 Suicidal ideas or gestures 8. Retardation (Slowness of thought and speech, impaired
4 Attempts at suicide (any serious attempt rates 4) ability to concentrate, decreased motor activity)
0 Normal speech and thought
4. Insomnia, Initial 1 Slight retardation at interview
0 No difficulty falling asleep 2 Obvious retardation at interview
1 Complains of occasional difficulty falling asleep—ie, 3 Interview difficult
more than 1/2 hour delay 4 Complete stupor
2 Complains of nightly difficulty falling asleep
9. Agitation
5. Insomnia, Middle 0 None
0 No difficulty 1 Fidgetiness
1 Patient complains of being restless and disturbed during the night 2 Playing with hands, hair, etc.
2 Waking during the night—any getting out of bed rates 2 (except 3 Moving about, can’t sit still
for purposes of voiding) 4 Hand wringing, nail biting, hair-pulling, biting of lips

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10. Anxiety Psychic 14. Genital Symptoms
0 No difficulty 0 Absent
1 Subjective tension and irritability 1 Mild
2 Worrying about minor matters 2 Severe
3 Apprehensive attitude apparent in face or speech Symptoms such as:
4 Fears expressed without questioning Loss of libido
Menstrual disturbances
11. Anxiety Somatic
0 Absent 15. Hypochondriasis
1 Mild 0 Not present
2 Moderate 1 Self-absorption (bodily)
3 Severe 2 Preoccupation with health
4 Incapacitating 3 Frequent complaints, requests for help, etc.
Physiological concomitants of anxiety such as: 4 Hypochondriacal delusions
Gastrointestinal—dry mouth, wind, indigestion,
diarrhea, cramps, belching 16. Loss of Weight (Rate either A or B)
Cardiovascular—palpitations, headaches A. When Rating by History:
Respiratory—hyperventilation, sighing 0 No weight loss
Urinary frequency
1 Probable weight loss associated with present illness
Sweating
2 Definite (according to patient) weight loss
12. Somatic Symptoms Gastrointestinal 3 Not assessed
0 None
1 Loss of appetite but eating without staff encouragement; heavy B. On Weekly Ratings by Ward Psychiatrist, When Actual
feelings in abdomen Weight Changes are Measured:
2 Difficulty eating without staff urging; requests or requires 0 Less than 1 lb. weight loss in week
laxatives or medication for bowels or medication for G.I. symptoms 1 Greater than 1 lb. weight loss in week
2 Greater than 2 lb. weight loss in week
13. Somatic Symptoms, General 3 Not assessed
0 None
1 Heaviness in limbs, back, or head; backaches, headache, muscle 17. Insight
aches; loss of energy and fatigability 0 Acknowledges being depressed and ill
2 Any clear-cut symptom rates 2 1 Acknowledges illness but attributes cause to bad food,
climate, overwork, virus, need for rest, etc.
2 Denies being ill at all

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